VIDOR COMMUNITY HEALTH CLINIC INC (NPI# 1487669073) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487669073 |
| Entity Type | Organization |
| Organization Name | VIDOR COMMUNITY HEALTH CLINIC INC |
| Practice Address |
1290 Highway 12 Vidor TX 77662-4016 |
| Mailing Address |
Po Box 2202 Vidor TX 77670-2202 |
| Practice Telephone | 4097697795 |
| Practice Fax Number | 4097698721 |
| Mailing Telephone | 4097697795 |
| Mailing Fax Number | 4097698721 |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2010-02-19 |
| Authorized Official Name | LINDA J BOONE (PRESIDENT) |
| Authorized Official Telephone | 4097697795 |
| Authorized Official Credential | APN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
561872 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 119735203 | 05 | |
| TX | BCBS | RU0016 | 01 |
| TX | MEDICARE PART B | 00037H | 01 |
| Street Address |
1290 HIGHWAY 12 |
| City | VIDOR |
| State | TX |
| Zip Code | 77662-4016 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497033674 | Minor Home Healthcare & Housekeeping Associates | Custodial Care Facility | 2730 Hwy 12 Ste. 2, Vidor, TX 77662 | 2011-07-22 |
| 1356477764 | Vidor Pharmacy LLC. | Durable Medical Equipment & Medical Supplies | 1130 N Main St, Vidor, TX 77662 | 2007-02-27 |
| 1114566833 | Crystal Young | Nurse Practitioner | 2353 N Main St, Vidor, TX 77662-2610 | 2019-12-27 |
| 1770035966 | Terri Jo Clark | Nurse Practitioner | 2353 N Main St, Vidor, TX 77662-2610 | 2016-11-04 |
| 1952798191 | Suhani Bhakta | Family Medicine | 2353 N Main St, Vidor, TX 77662-2610 | 2015-04-24 |
| 1801999727 | Jason M Holmes | Chiropractor | 2612 N Main St, Vidor, TX 77662-2674 | 2006-09-06 |
| 1598038564 | American Eagle Medical Supply | Durable Medical Equipment & Medical Supplies | 2612 N Main St, Vidor, TX 77662-2674 | 2012-02-21 |
| 1174023691 | Kathy Blankenship | Home Health | 615 Evangeline Dr, Vidor, TX 77662-2719 | 2018-02-21 |
| 1770646150 | Promed Medical & Respiratory Supply, Inc. | Durable Medical Equipment & Medical Supplies | 1465 N Main St, Vidor, TX 77662-3009 | 2006-12-18 |
| 1972584852 | Texas Total Care,inc. | Home Health | 1880 N Main St, Vidor, TX 77662-3018 | 2005-11-08 |
| Find all providers in zip 77662 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780232652 | Talanna Ceara | Nurse Practitioner | 498 Lakewood Dr, Vidor, TX 77662-3903 | 2019-09-03 |
| 1114566833 | Crystal Young | Nurse Practitioner | 2353 N Main St, Vidor, TX 77662-2610 | 2019-12-27 |
| 1770035966 | Terri Jo Clark | Nurse Practitioner | 2353 N Main St, Vidor, TX 77662-2610 | 2016-11-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487255162 | Shaida Rahmatinick | Nurse Practitioner | 1515 W 22nd St, Houston, TX 77008-1501 | 2020-11-08 |
| 1891396586 | Stacey Lynne Ready | Nurse Practitioner | 200 Uptmore Rd, West, TX 76691-2339 | 2020-11-08 |
| 1992306609 | Jillian Mcclintock | Nurse Practitioner | 2506 Graystone Ln, Corinth, TX 76210-1607 | 2020-11-08 |
| 1851992515 | Stacie A Gregg | Nurse Practitioner | 1229 Johnny Ln, San Angelo, TX 76905-2331 | 2020-11-07 |
| 1285235929 | Activate Family Health, Pllc | Nurse Practitioner | 203 E Davis St Ste F-1026, Conroe, TX 77301-3159 | 2020-11-07 |
| 1629679782 | Kristen Aili Johnson | Nurse Practitioner | 3850 Fm 18, Abilene, TX 79602-2004 | 2020-11-05 |
| 1376144303 | Stephanie Renee Knight | Nurse Practitioner | 4326 Egret Dr, Seabrook, TX 77586-2557 | 2020-11-05 |
| 1457952319 | Olufunke Oyindamola Oshoba | Nurse Practitioner | 200 Odyssey Ln, Mansfield, TX 76063-3438 | 2020-11-05 |
| 1518568419 | Ian Mardis | Nurse Practitioner | 12528 Tierra Encino Dr, El Paso, TX 79938-4525 | 2020-11-05 |
| 1851992994 | Angela Davis | Nurse Practitioner | 9523 Scanlan Heights Ln, Missouri City, TX 77459-5503 | 2020-11-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.